Neuroplasticity and Cognitive Rehabilitation Post-Stroke: The Impact of Neurosurgical Interventions
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Abstract
Background: Stroke is a major cause of long-term disability, and severe cases may require neurosurgical intervention to reduce intracranial pressure and prevent secondary brain injury. However, the relationship between neurosurgical management, neuroplastic recovery, and long-term cognitive rehabilitation remains insufficiently studied in Pakistan. Objective: To evaluate cognitive and functional recovery over 12 months among stroke patients managed with or without neurosurgical intervention in selected tertiary-care hospitals of Karachi. Methods: This longitudinal cohort study included 148 adult stroke patients, including 62 who underwent neurosurgical intervention and 86 managed without surgery. Cognitive and functional outcomes were assessed at baseline, 3 months, 6 months, and 12 months using MoCA, mRS, and Barthel Index. Multivariable regression identified predictors of better 12-month cognitive outcome. Results: The neurosurgical group had worse baseline MoCA, mRS, and Barthel Index scores. MoCA improved from 14.2 ± 4.1 to 22.1 ± 3.9 in the neurosurgical group and from 17.8 ± 4.5 to 23.6 ± 3.4 in the non-neurosurgical group. Regular rehabilitation was associated with the greatest MoCA improvement. Early rehabilitation, higher education, younger age, lower baseline severity, and neurosurgical intervention were significant predictors of better 12-month cognition. Conclusion: Neurosurgical intervention may preserve the opportunity for later cognitive recovery in severe stroke, but optimal outcomes depend on early and sustained rehabilitation
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